To see the other types of publications on this topic, follow the link: Paediatric hospital care.
Dissertations / Theses on the topic 'Paediatric hospital care'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 35 dissertations / theses for your research on the topic 'Paediatric hospital care.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Elo, Jyrki A. I. "The impact of surgical day care on hospital inpatient utilization in a paediatric population." Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/27876.
Full textAbstract:
Day care surgical services have been marketed as a cost saving alternative for inpatient care. There is evidence that the cost per episode of day care surgery is 50-70 percent less than a comparable episode in an inpatient ward. In addition, avoiding hospitalization has particular relevance for paediatrics, because of the undesirable effects of hospital stay on children. However, both cost savings and the quality-based need to decrease hospitalizations of children will be fullfilled only if each patient cared for in a day care surgery unit would otherwise have been an inpatient and the bed vacated by day care surgery use would not be filled in by other patients.
In a previous B.C. study based on the total population a significant component of day care surgery was found to augment total utilization, suggesting generation of surgical activity rather than substitution. The present study was designed to examine the substitution/generation issue in the paediatric (0-14 years) population, both because experts questioned the generalizability of the findings to the paediatric population, and because of the dramatic reduction in paediatric utilization in Canada during the period since the mid-1960s. The contention was that the introduction of day care surgery may have been an important factor in this downtrend.
The relationship between paediatric day care surgery use and hospital inpatient utilization was analyzed in B.C. in each of the years 1968-1976 and 1981/82-1982/83 and using a time series/cross-section study design. The data frame consisted of all B.C. school districts, in each of the study years, yielding 825 data points. Using a multivariate regression analysis, it was possible to estimate what hospital utilization patterns would have been in the absence of day care surgery capacity, and hence isolate estimates of the net impact of day care surgery on paediatric inpatient use.
Findings on the relationship between day care surgery use and paediatric medical/surgical and surgical inpatient utilization strongly support the view that paediatric day care surgery has been largely an add-on to the total hospital care system. Statistically significant substitution effect was revealed only for the most narrowly defined inpatient surgery category which more closely resembled day care surgery-type cases, after controlling for potential confounding effects of age and sex, paediatric bed capacity, different socioeconomic characteristics and time- and district-specific factors. Even here, less than 10 percent of day care surgery represented substitution for inpatient surgery and over 90 percent appeared to be generation of new activity to the hospital system as a whole. Furthermore, paediatric beds which were "saved" by day care surgery use were filled with increased utilization by non-day care surgery eligible surgical patients and by medical cases. The main driving force behind hospital utilization in the 0-14 year age group was paediatric bed availability even after standardization for age, sex, physician stock, measures of socioeconomic status, and other district- and year-specific effects.
According to this study paediatric day care surgery has not been a cost saving alternative for inpatient care in B.C. in 1968-1982/83. Neither has it reduced overall hospitalizations in the paediatric population.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
2
Fitzwanga, Kaiser. "Transfusion practices among children undergoing cardiac surgery admitted to the Red Cross War Memorial Children's Hospital Paediatrics Intensive Care Unit." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29879.
Full textAbstract:
Objective- We aimed to describe the use of blood products following cardiac surgery, as well as the outcomes and factors associated with post-operative blood product use
Design- Prospective, single centre observational study
Setting- Paediatric intensive care unit (PICU) in Cape Town, South Africa
Patients- One hundred and twenty-six children <18 years old admitted to the PICU following cardiac surgery between July 2017 and January 2018
Interventions- None
Measurements and Main Results- The data was prospectively obtained from blood bank charts, intraoperative and PICU observation charts. Demographic data, intraoperative details and post-operative blood product use were extracted from patient records and entered in a standardised case record form. Fifty three percent of children received blood products following cardiac surgery. The blood products transfused included cryoprecipitate (30.9%), packed red cells (22.2%), albumin (18.3%), fresh frozen plasma FFP (15.9%) and platelet concentrate (15.1%). Low haemoglobin level was commonest indication (86%) for red cell use. Bleeding was the commonest indication for FFP (70%) and cryoprecipitate (67%) use. Thrombocytopenia was the commonest indication (84%) for platelet use while hypotension episodes were predominant (95%) in those who received albumin. The standardized mortality ratio was 3.1 vs 0, respectively, among transfused versus non-transfused patients (p<0.0001). The median (IQR) duration of PICU stay was 5 (3-11) vs 2 (2-5) days, respectively in those transfused versus non-transfused (p<0.0001). The median (IQR) ventilation duration was 47(22-132) hours vs 20 (6-27) hours, respectively among the transfused versus non-transfused (p=<0.0001). The factors associated with blood-product use post cardiac surgery include previous cardiac surgery, younger age, lower weights, and prolonged coagulation parameters (p=<0.05).
Conclusion- There is high usage of blood products among children post cardiac surgery. The children transfused had a longer ICU stay, ventilation duration, and higher standardized mortality ratio compared to the non-transfused.
3
Ameer, Ahmed. "Safety measures to reduce medication administration errors in Paediatric Intensive Care Unit." Thesis, University of Hertfordshire, 2015. http://hdl.handle.net/2299/16352.
Full textAbstract:
Objective: Medicine administration is the last process of the medication cycle. However, errors can happen during this process. Children are at an increased risk from these errors. This has been extensively investigated but evidence is lacking on effective interventions. Therefore, the aim of this research is to propose safety measures to reduce medication administration errors (MAE) in the Paediatric Intensive Care Unit (PICU). Method: The research was carried out over five studies; 1) systematic literature review, 2) national survey of PICU medication error interventions, 3) retrospective analysis of medication error incidents, 4) prospective observation of the administration practice, and 5) survey of PICU healthcare professionals' opinions on MAE contributory factors and safety measures. Results: Hospital MAE in children found in literature accounted for a mean of 50% of all reported medication error reports (n= 12552). It was also identified in a mean of 29% of doses observed (n= 8894). This study found MAE retrospectively in 43% of all medication incidents (n= 412). Additionally, a total of 269 MAEs were observed (32% per dose observation). The characteristics of the interventions used to reduce MAE are diverse but it illustrated that a single approach is not enough. Also for an intervention to be a success it is fundamental to build a safety culture. This is achieved by developing a culture of collaborative learning from errors without assigning blame. Furthermore, MAE contributing factors were found to include; interruptions, inadequate resources, working conditions and no pre-prepared infusions. The following safety measures were proposed to reduce MAE; 1) dose banding, 2) improved lighting conditions, 3) decision support tool with calculation aid, 4) use of pre-prepared infusions, 5) enhance the double-checking process, 6) medicine administration checklist, and 7) an intolerant culture to interruption. Conclusion: This is one of the first comprehensive study of to explore MAE in PICU from different perspectives. The aim and objectives of the research were fulfilled. Future research includes the need to implement the proposed safety measures and evaluate them in practice.
4
Kruger, Irma. "Paediatric and neonatal admissions to an intensive care unit at a regional hospital in the Western Cape." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86757.
Full textAbstract:
Thesis (MMed)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Objective: The aim of the study was to determine the outcome of critically ill neonates and children admitted to a general intensive care unit in a large regional hospital (Worcester) in the Western Cape. A secondary aim of the study was to determine the risk factors for death in these neonates and children. Methodology: This was a retrospective descriptive survey of all paediatric admissions (under 13 years of age; July 2008 till June 2009) to an intensive care unit at a large regional hospital in Worcester, South Africa. Data collected included: demography, admission time, length of stay, diagnoses, interventions and outcome. Outcome was defined as successful discharge, death or transfer to a central hospital. Results: There were 194 admissions including children and neonates. The files of 185 children and neonates were analysed, while 8 children were excluded due to incomplete data set and one patient was a surgical admission. The male: female ratio was 1.3: 1 and the majority of patients (83%) admitted, were younger than 12 months of age at admission with a mean age of 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) of admissions were successfully discharged, nearly a quarter (24%) transferred to central hospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birth asphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patients requiring airway assistance, were more likely to experience an adverse event (p=0.0001) and invasive ventilation was associated with an increased risk for a poor outcome (p=0.00). Conclusion: The majority of children requiring access to a paediatric ICU are younger than one year of age. The common causes of death are acute lower respiratory tract infections, acute gastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa should offer intensive care to children as the majority of their admissions can be successfully cared for without transfer to tertiary hospitals. To our knowledge, this is the first study reporting admissions and outcome of neonates and children cared for in a mixed intensive care unit in a large regional hospital in South Africa. This study suggests that large regional hospitals in South Africa should have mixed intensive care units to improve child survival.
5
Coetzee, Saskia. "A retrospective review of patients admitted to the Paediatric ICU at Red Cross War Memorial Children's Hospital during 2010 with the clinical diagnosis of measles or measles-related complications." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/6017.
Full text
6
Reddy, Deveshnee. "Acinetobacter baumannii infections in the paediatric intensive care unit of a tertiary hospital in South Africa." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13974.
Full textAbstract:
Acinetobacter baumannii (A. baumannii) is now increasingly recognised as an important cause of nosocomial infections in paediatric intensive care unit (PICU) patients, particularly in developing countries, where it contributes significantly to morbidity and mortality. Furthermore, it has been documented that emerging antimicrobial resistance patterns complicate antibiotic choice in these patients. At present, more paediatric data is needed regarding these infections. This is a retrospective case-control study that aims to document the demographic data and relevant clinical details of patients in whom A. baumannii was cultured, either from blood or respiratory specimens (thus including both infections and colonisation), in the PICU at Red Cross War Memorial Children's Hospital (RCWMCH) during 2010. Secondary objectives include comparing these patients with those in whom A. baumannii was not cultured and determining which isolates were causing infection and which were colonisers. In addition; of the isolates regarded as infections, documenting the antimicrobial sensitivities and resistance of the organisms cultured, determining whether infections were late or early onset and determining whether specific bed numbers were consistently involved.
7
Duncan, Kristal. "A cost comparison analysis of paediatric intermediate care in a tertiary hospital and an intermediate, step-down facility." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25251.
Full textAbstract:
Background: According to the National Cancer Registry of South Africa 600-700 new cases of paediatric cancers have been reported every year for the past 25 years. While in the year 2000 HIV/AIDS was responsible for 42 479 deaths in children under five. However support for and research in general for the paediatric intermediate care (encompasses palliative, sub-acute and respite care) needed by these children remains sparse. Costing studies are even rarer, with the few studies conducted in South Africa reporting a broad range of average costs per inpatient day. Methods: A retrospective cost analysis for the period April 2014-March 2015 was undertaken from the provider perspective. Costs of paediatric intermediate care were estimated for an intermediate stepdown facility and a tertiary hospital in Cape Town, South Africa. A step down costing approach was employed, and the costs were inflated to 2016 values and expressed in Rand and USD using an exchange rate of 1 USD = R14.87. Results: Cost per inpatient day was USD 713.09 at the hospital and USD 695.17 at the step-down facility. The cost for a paediatric patient who is HIV/TB co-infected was USD 7130.94 and USD 6951.67 at the hospital and step-down facility respectively, assuming an average length of stay (ALOS) of 10 days. For a patient who has a terminal brain carcinoma the cost was USD 19966.63 and USD 19464.69 at the hospital and step-down facility respectively, assuming an ALOS of 28 days. Personnel costs accounted for 60% of the total cost at the hospital, compared to only 17% of the total costs at the step-down facility. Overhead costs accounted for 12.33% at the step-down facility, almost 3 times that of the hospital (4.48%). Conclusions: The study highlights that the drivers of cost are not uniform across settings. Providing intermediate care at a step-down facility can be more cost-saving than providing this care at a hospital, there are however areas in which more savings could be realized. The costs presented in this study were considerably higher than those found in other studies, however, the paucity of cost data available in the area of paediatric intermediate care makes comparisons difficult.
8
Maughan, Samantha Jane. "Outcomes of paediatric art patients down-referred from a tertiary and a regional hospital to primary care facilities in Buffalo City Municipality, Eastern Cape." University of the Western Cape, 2020. http://hdl.handle.net/11394/8054.
Full textAbstract:
Master of Public Health - MPHBackground: According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) 340 000 children between 0-14years of age are living with HIV in South Africa as of 2019. Decentralization of HIV services was included in South Africa’s paediatric guidelines since 2010 in a bid to improve access to care. The current study sought to address the paucity of Eastern Cape (EC) data on the outcomes of down-referred paediatric antiretroviral therapy (ART) patients. These outcomes included retention in care (RIC) and virological suppression after 12 months Methodology: This retrospective analysis was conducted in the Buffalo City Municipality (BCM) district of the EC. The study population included HIV positive males and females, 0-14 years of age at transfer, who were initiated on ART at a tertiary or a regional hospital and subsequently down-referred, between June 2013 and June 2017. Data were collected from electronic databases at the facilities (Tier.net), patient files and patient registers. A descriptive analysis was performed using SPSS Statistics software version 26. Results: In total, 80.1% of patients successfully down-referred to a primary healthcare (PHC) facility, in a median of 42 days. Of those, 95.4% of patients were retained in care at 6 months and 93.1% at 12 months after arrival, with a median of 4 scheduled monthly visits missed. For those with results, virological suppression was maintained in 96.7% of patients at 6 months, 92.2% at 12 months and 96.2% for the entire post-transfer period of 2-14 months. In the 2-14 months post down-referral only 76.9% of patients had at least one viral load (VL) result and 50.3% had one CD4 result. For those with results, immune response (IR) to ART was maintained in 100% of patients at 6 months, 94.3% at 12 months and 97.7% in the 2-14 month period post successful down-referral. Conclusions: This study confirmed that loss to follow-up (LTFU) and treatment interruption at the point of transfer are significant risk factors for paediatric ART patients. This study also demonstrated high levels of RIC once patients had successfully down-referred. However, missed clinic visits suggest possible treatment interruptions for many patients post down-referral. While good virological and immunological responses to ART were maintained at the PHC facilities, suboptimal VL and CD4 monitoring was highlighted by the low proportion of available results. Therefore, while there are a number of issues to address, this study confirms that down-referral is a feasible option for up-scaling paediatric HIV care in the EC.
9
Machingaidze, Pamela Rudo. "The clinical use and indications for head computed tomography scans in paediatric ambulatory care (short stay ward and medical emergencies) at a children’s hospital over a one-year period, 1st January-31st December 2013." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29345.
Full textAbstract:
Background: Computed tomography (CT) imaging is an indispensable tool in the management of acute paediatric illness. It offers quick answers, allowing timely lifesaving decision-making. Clinical evidence is required to maximise its benefits against radiation-exposure risks to patients and cost to the healthcare system.
Aims: The study aimed to retrospectively investigate clinical presentation and indications of head CT at a tertiary paediatric hospital.
Methods: Records of children presenting with acute illness to the medical emergency unit, excluding trauma, of Red Cross War Memorial Children’s Hospital, Cape Town, over one year (2013) were retrospectively reviewed. Participants were included if they underwent head CT scan within 24 hours of presentation. Clinical data were extracted from records and CT findings reported by a paediatric radiologist.
Results: Inclusion criteria were met by 311 patients; 188 (60.5%) were boys. The median age was 39.2 (IQR 12.6-84.0) months. Commonest indications were seizures (n=169;54.3%), reduced level of consciousness (n=140;45.0%), headache (n=74;23.8%) and suspected ventriculoperitoneal shunt (VPS) malfunction (n=61;19.7%). In 217 (69.8%) patients CT showed no adverse findings. In the 94 (30.2%) patients in whom CT abnormalities were detected, the predominant findings were hydrocephalus (n=54;57.4%) and cerebral oedema (n=29;30.9%). Abnormal CT findings were commoner in patients with nausea or vomiting (n=21;9.3%, p=0.05) papilloedema (n=3;1.3%, p=0.015) and long tract signs (n=23;10.2%, p=0.02). Forty-seven patients (15.1%) required surgical intervention after CT of which 40 (85.1%) needed a ventricular drainage procedure. A larger proportion of patients with VPS (25/62;40.3%) required surgical intervention compared to patients without VPS (22/249;8.8%, p <0.001)
Conclusion: Most children presenting with acute illness (excluding trauma) and undergoing emergency head CT have normal findings. Patients with ventriculoperitoneal shunts constituted a large proportion of patients requiring intervention after CT. Considerations should be made to use clinical presentation to select patients most likely to benefit from CT.
10
Bågenklint, Åsa, and Susanne Stenberg. "Föräldrars upplevelser av vården när deras barn vårdas på en pediatrisk avdelning." Thesis, Linköpings universitet, Avdelningen för omvårdnad, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-134973.
Full textAbstract:
Inledning: Att vara på sjukhus med sitt akut sjuka barn är för många föräldrar en traumatisk upplevelse. Betydelsen av ett professionellt bemötande är av stor vikt för hur upplevelsen av vårdtiden blir. Syftet var att beskriva föräldrars upplevelser av vården när deras barn vårdades på en pediatrisk avdelning.Metod: För att besvara syftet och få en djupare förståelse för föräldrars upplevelse valdes en kvalitativ metod med semistrukturerade intervjuer. Totalt inkluderades åtta föräldrar i studien. Intervjuerna transkriberades och analyserades enligt tematisk analysmetod. Fynd: Analysen resulterade i tre teman: 1. Omvårdnadens olika uttryck: Genom att bli bemött med respekt och bli sedd som förälder upplevdes en trygghet i vården av barnet. 2: Föräldrars utsatthet: Att vara förälder till ett sjukt barn innebär en sårbarhet, och Sjukhusmiljö: Samtliga föräldrar uttryckte en tacksamhet över sjukvårdens olika resurser. Konklusion: Kompetent personal och ett gott bemötande är enligt föräldrar viktiga faktorer för att uppleva trygghet i vården. Det är av stor vikt att personal besitter god kompetens och vidareutbildas för att erhålla och bibehålla denna. En anpassning av sjukhusmiljö för barn och familjer, t.ex. i form av lekterapi, är av stor betydelse.Introduction: To stay in the hospital with a critically ill child is for many parents a traumatic experience. The professionals´ approach has a great impact on how the actual treatment time is experienced. Purpose: The purpose was to describe parents' experience of care when their children were being cared for in a paediatric ward. Method: A qualitative approach with semi- structured interviews was chosen to answer the purpose, and get a deeper understanding of parents' experience. A total of eight parents were included in the study. The interviews were transcribed and analysed with thematic analysis. Findings: The analysis resulted in three themes: 1. Different expressions of nursing care: Parents wanted to be treated with respect, and be seen as a parent which in return made them feel confident in the care of the child. 2. Parental exposure: Being the parent of a sick child means vulnerability and 3 Hospital environment: All the parents in this study expressed a gratitude for the healthcare resources. Conclusion: Skilled personnel and a good attitude are key factors when experiencing confidence in health care. It is vital that staff possess good skills and further training to obtain and maintain this. It is also important with an adaptation of the hospital environment for children and families, such as in the form of play therapy.
11
Vosloo, Ruan. "An Assessment of Critically Ill Children admitted to a General High Care Unit in a Regional Hospital in the Western Cape, South Africa." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33077.
Full textAbstract:
Background Many critically ill children in South Africa are cared for in regional hospitals by general Paediatricians. Critically ill adults and children are usually cared for in the same units. There is limited data on the numbers of children admitted and the outcomes of these children. Objective To describe the patient profile and outcomes of children admitted to a general high care unit (HCU) in a regional hospital in the Western Cape, South Africa. Methods This was a retrospective descriptive study of all children admitted to the HCU of George Regional Hospital during a one year period (2016). Demographic data, HIV, anthropometric data, immunisation status, diagnoses, medical interventions, length of stay, death or survival, and referral data to the tertiary paediatric intensive care unit (PICU) were collected. The PIM3 score and Standardized Mortality Ratio (SMR) was calculated. Results Thirty percent (144/468) of the HCU admissions were children. Most (70%) were admitted after hours. Half were under 9 months (range 3 days to 149 months). Sixty-five percent of the children required respiratory support and 45% needed inotropic support. Twenty percent of the children were transferred to the PICU. Twelve children (8,5%) died with most deaths (75%) occurring at regional level. Half of the deaths were due to sepsis with pneumonia (25%) and diarrhoea with shock (25%) accounting for the rest. The cumulative PIM3 score was 9.049 (95%CI 6.430-11.668) with an SMR of 1.326 (95%CI 1.028-1.866) observed. Conclusion Critically ill children accounted for a third of HCU admissions. Most children needed medical interventions. These require specific training and equipment that are often lacking. After hours admissions also put strain on limited staff. Most children were successfully discharged demonstrating a good outcome. This was achievable with good channels of communication and transport to a tertiary PICU.
12
Kahl, Gisela. "Low grade gliomas treated at the University of Cape Town Academic Hospital complex: 2001-2017." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33823.
Full textAbstract:
Background: The majority of central nervous system tumours in children are low grade gliomas (LGG). Long-term survival rates are high with a slow, progressive course. Tumour location and extent of resection affect outcome. Adjuvant therapy has an important role. Rationale: This study evaluated the demographic data of our patient population, the characteristics of LGGs in our setting, the time to presentation, and the role of adjuvant therapy including more targeted, novel biologic therapy such as BRAF/MEK inhibitors. The outcome of children with LGGs in our institution was assessed. Methods: A retrospective analysis was performed on all children < 15 years of age diagnosed with a LGG at Red Cross War Memorial Children's Hospital (RCWMCH) between 2001 and 2017. Data were collected from patient hospital folders, as well as paediatric oncology records and Groote Schuur Hospital radiotherapy records. Results: Eighty-six children aged 0.10-13.76 years (median 4.74 years) were diagnosed with LGGs between 2001 and 2017 at RCWMCH. Median time to presentation was 60 days. Sixtyfive patients (76%) were classified as having a WHO Grade I and 21 patients WHO Grade II (24%) tumours. Five patients (6%) had metastatic disease at presentation. The most common sites involved were the cerebellum (27%), hypothalamus (17%) and cerebrum (14%). The most common histology was juvenile pilocytic astrocytoma (JPA) (n=62; 73%). Gross total resection (GTR) was achieved in 21 patients (24%). Twenty-four patients (27%) received chemotherapy of which 11 patients progressed. Twenty-two patients received radiotherapy (26%), of which 3 patients progressed. The estimated 5-year overall survival (OS) was 86.8% and the estimated 5-year progression free survival (PFS) was 42.8%. The presence of a BRAFV600E mutation was checked in 4 patients since 2013, all had JPA histology, and all were negative. Discussion: Our patient demographic differed from published data with respect to younger age at presentation and female predominance. Time to presentation was relatively short. The majority of LGGs were cerebellar, with JPA histology being the most common. GTR was achieved in almost a quarter of patients. WHO Grade II histology did not significantly impact PFS and OS. Children < 3 years had a lower PFS compared to children > 3 years, but OS was similar. OS in this study was comparable to published data in developed countries, however PFS was slightly lower. Conclusion: Our outcomes are similar to those achieved in developed countries. Chemotherapy and radiotherapy are valuable adjuncts to treatment. The presence of a BRAF alterations should be tested in recurrent/progressive disease, to guide use of novel treatments.
13
Moore, Ryan. "International Normalised Ratio Monitoring in Children: Comparing the accuracy of portable point-of-care monitors to standard of care laboratory monitoring at Red Cross War Memorial Children's Hospital." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32880.
Full textAbstract:
Background. There is an increasing trend in the use of long-term oral anticoagulation therapy in children. Monitoring the international normalised ratio (INR) is an integral part in management of these patients, but standard laboratory testing of the INR presents challenges in this age group. Point-of-care INR monitors such as the Mission® PT/INR monitor provide advantages in efficiency and accessibility but have not been evaluated for accuracy in the South African paediatric setting. Objectives. This is a feasibility study with the aim to evaluate the accuracy of the Mission® PT/INR Monitor in comparison to standard laboratory INR measurement, in children presenting for INR testing. Methods. We compared the accuracy of the Mission® PT/INR monitor to the Sysmex Cs2100i laboratory analyser in 37 children aged between 1 year and 17 years, who presented for INR testing. The sample size was limited due to time constraints. 40 paired POC INR and laboratory INR values were obtained. Results. The majority of participants in the study were outpatients (62%) and required INR testing as part of screening in non-cardiac disease (81%) - the majority had chronic liver disease, and a minority were on warfarin therapy (13.5%). The mean INR value on the Mission® PT/INR was 1.49 (standard deviation (SD) 0.73) and was comparable to the Sysmex Cs-2100i (mean INR value 1.39 with SD 0.69). The Bland-Altman difference plot revealed good agreement. Bias between the two methods was 0.13 (SD 0.23). In total, 92.5% of POC INR values were within 0.5 units of laboratory INR value. Conclusion. The Mission® PT/INR point-of-care monitor has a clinically acceptable level of accuracy in children when compared with laboratory INR measurement, but larger studies are needed in the paediatric setting to evaluate patient safety and clinical outcomes. There is a need for implementing POC INR monitoring in outpatient settings but this practice will require robust assessment of infrastructure and quality control before application.
14
Davies, John Quail. "Post transplant lymphoproliferative disoders in liver transplant recipients : cases at Red Cross Children's Hospital Cape Town." Master's thesis, University of Cape Town, 2002. http://hdl.handle.net/11427/10375.
Full textAbstract:
Includes bibliography.Between 1985 and 2000, 43 children (age range 6 months-13 years) underwent liver transplantation at Red Cross Children's Hospital. In 46% of these cases, viral infections resulted in considerable morbidity and mortality. Included in this group were: de novo hepatitis B (5 patients, 2 deaths), EBV-related post-transplantation lymphoproliferative disease (6 patients, 4 deaths) and CMV disease (9 patients, 4 deaths).
15
Naidoo, Reené. "Epidemiology of Staphylococcus aureus bacteraemia at a tertiary children's hospital in Cape Town, South Africa." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/3064.
Full text
16
Mvalo, Tisungane Knox Titus. "Blood stream infections in oncology patients at Red Cross War Memorial Children's Hospital, Cape Town." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27377.
Full textAbstract:
Background: Infections cause significant morbidity and mortality in children with cancer, which may be related to the cancer or treatment received. There is paucity of data on the epidemiology of bloodstream infection (BSI) in sub-Saharan Africa. To address this knowledge gap, the present study was conducted at Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town, South Africa. Methods: Structured literature review: From 1 April 2016 to 31 May 2016 a PubMed search was undertaken on BSI in Paediatric Oncology. The search string used was (bacteraemia OR blood stream infection) AND (paediatric OR pediatric) AND (oncology). Studies that did not describe infection patterns, risk factors for infection, morbidity/mortality, articles not in English and those exclusively describing neonatal or ICU patients were excluded from full review. Retrospective cohort study: A retrospective cohort study was conducted at the haematology-oncology unit of RCWMCH. All positive blood cultures from RCWMCH oncology patients taken between 1 January 2012 and 31 December 2014 were retrieved to identify patients who had BSI. Results: Structured literature review: 508 abstracts / articles were initially retrieved and screened. 478 studies were excluded as per the literature review exclusion criteria. Thus, 30 articles were included in full analysis, 17 retrospective studies, 4 prospective multicentre studies, 6 prospective single centre studies, 2 systematic reviews and 1 case report. All were observational studies. This literature review showed that BSI is a frequent and important cause of morbidity and mortality in paediatric oncology. Gram-positive bacteria was noted to be the leading type of pathogen causing BSI. Increased risk of BSI may be from the cancer itself, chemotherapy, hospitalisation, central venous catheter insertion, and oncology patients were at risk of multi-drug resistant infection. Research gaps noted included paucity of studies from Sub-Saharan Africa, limited analysis of the antimicrobial susceptibility of causative microorganisms and limited description of fungal BSI in oncology patients. Retrospective cohort study: From 436 positive blood culture results, 150 BSI episodes were identified amongst 89 patients; 49.1% of the culture isolates were Gram-positive bacteria, 41.6 were Gram-negative bacteria and 9.3% were fungal. Coagulase Negative Staphylococcus and Viridans Group Streptococcus were the most common Gram-positive isolates, and Escherichia coli and Klebsiella species the commonest Gram-negative isolates. The majority of BSI episodes occurred in patients with haematological malignancies (74%), in the presence of severe neutropaenia (76.4%) and whilst on or following chemotherapy (88%). Complications occurred in 14% of the BSI episodes. Fungal infections had the highest prevalence of complications (21.4%). Three children died during BSI as a result of multidrug resistant isolates, giving a case-fatality rate of 2%. Conclusion: The findings of our cohort study show that BSI are mainly caused by Gram-positive bacteria and associated with a low case-fatality rate. The results of this study are consistent with worldwide experience of BSI in paediatric oncology patients. This study provides an understanding of the spectrum of organisms causing BSI and the outcome of BSI in a sub-Saharan African context.
17
Kija, Edward Nkingwa. "Bone metabolism abnormalities in children with epilepsy at Red Cross War Memorial Children's Hospital, Cape Town, South Africa." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27013.
Full textAbstract:
Introduction: Epilepsy is the most common neurological condition worldwide. Literature on the antiepileptic medications and biochemical markers of bone metabolism has revealed inconsistent results. Most of these studies were undertaken in Europe and America where the burden and the associated comorbidities are different to the ones in Africa. Methods: A hospital based case control study was undertaken at Red Cross War Memorial Children's Hospital where children were recruited from a dedicated Epilepsy clinic and controls were obtained from a day surgical ward. Blood and urine samples were taken for the assessment of markers of bone metabolism. Results: Seventy-five cases and 75 controls were recruited. The median age for the children with epilepsy was 9 years with a range of 1 to 17 and controls 3 years with a range of 1 to 12. Vitamin D deficiency was present in 11(16.2%) of children with epilepsy compared to 6(8.8%) in the control group. Vitamin D insufficiency was present in 30(44.1%) in children with epilepsy compared to 27(39.7%) in the control group. Children with epilepsy on enzyme inducing AEDs had lower mean Vitamin D levels (24.67±11.4 vs 30.72±7.4, p=0.08), lower mean Vitamin D2 (0.25±0.07 vs 0.4±0.17,p=0.0018),lower mean Vitamin D3 (1.61±1.06 vs 2.58±0.86,p=0.004), lower mean serum phosphate levels (1.39±0.2 vs 1.76±0.7,p=0.000) and a higher mean parathyroid hormone levels (4.47±2.33 vs 2.7±0.97, p=0.03) compared to the control group. Children with Epilepsy on enzyme inhibitors had higher mean Vitamin D2 (0.44±0.37 vs 0.25±0.07,p=0.000004) and mean Vitamin D3 (2.26±0.86 vs 1.61±1.06,p=0.028) compared to children on enzyme inducers. Dietary intake and ancestry did not influence Vitamin D levels between the cases and controls. Conclusion and Recommendations: Vitamin D deficiency is common in children with epilepsy on AEDs. Children on enzyme inducing AEDs should be investigated for vitamin D deficiency and managed accordingly.
18
Meyer, Mandy-Lyn. "A review of children admitted to a regional hospital in Cape Town with community acquired pneumonia." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20297.
Full textAbstract:
Background: Pneumonia is a leading cause of death in children under - five. Epidemiology in our province at regional level has not been described since 2004, when HAART was rolled out and pneumococcal conjugate vaccination (PCV) was introduced. Objectives: Describe the demographic profile, disease severity, risks for transfer and mortality and the management of children >2 months, admitted with CAP over a one year period. Methods: Retrospective descriptive study of every second patient (>2 months to 13 years) admitted to Somerset Hospital in 2012 with the diagnosis of CAP. Demographic, clinical and outcome data were extracted from hospital records and analysed using STATA®. Results: Of 380 cases reviewed, 90% had severe disease; the median age was 9.4 months (IQR 4.8 - 23). Of these 89 (23%) were LBW (<2500g) and 75 (20%) were born premature. Median age at presentation for these groups was 5.7 months compared with 10.6 months in t erm children ( p=0.0003 ). Forty - one (12%) were severely malnourished; 34 (9%) were HIV - positive. Children below 1 0 /12 were more likely to have incomplete immunisations (57/190, p=0.011). Only 15% of TB - exposed children < 5 years were on Isoniazid Prevention Therapy (IPT). Prevalence of comorbid conditions was high. Median duration of stay was 3 days (IQR 2 - 6); this increased to 6.5 (IQR 4.5 - 9.5) with neurological disease and 6 (IQR4 - 10) with proven RSV. Seventeen patients (4.5%) required transfer to tertiary level. Mortality rate was 0.5%. Conclusion: Preventative measures must focus on populations at risk - LBW and preterm children in first year of life, malnourished children and those with comorbidities like HIV. Immunisation and IPT rates can be improved.
19
Antwi, Sampson. "Audit of posterior urethral valve (PUV) in children at Red Cross Children Hospital, Cape Town, January 2002 - January 2009." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/11891.
Full textAbstract:
Includes abstract.Includes bibliographical references (leaves 64-72).
Posterior urethral valve (PUV) is a congenital obstructing membrane of the male urethra. It is the commonest cause of bladder outlet obstruction in male children. PUV as a cause of obstructive uropathy is an important cause of end stage renal failure (ESRF) in children. Early detection and surgical intervention can slow down progression to ESRF.
20
Zar, Heather. "Pneumonia in HIV-infected children admitted to hospital in Cape Town, South Africa." Doctoral thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/11105.
Full textAbstract:
Bibliography: leaves 129-163.There is little information on the aetiology and outcome of HIV-associated pneumonia in African children and no comprehensive data from South Africa. Studies of HIV-infected adult in Africa reported that the spectrum of pulmonary disease differs from that of developed countries with tuberculosis and pyogenic pneumonia predominating and Pneumocystis carinii pneumonia (PCP) occurring uncommonly. Knowledge of the aetiology and outcome of pneumonia is important for the development of paediatric management guidelines and of policies for allocation of resources especially in South Africa, where the HIV pandemic has resulted in increasing numbers of HIV-positive children requiring admission to hospital or intensive care units for pneumonia. Furthermore in countries with limited resources, development of cost effective diagnostic procedures to investigate the aetiology of pneumonia is necessary.
21
Wiles, Jodi Isaacs. "Descriptive study evaluating the use of the Road to Health card by doctors in a tertiary paediatric hospital setting." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20295.
Full textAbstract:
Background: The South African Road to Health Card (RTHC) is a parent-held personal child health record used by health professionals and parents to monitor the health and development of a child. Low possession and retention of the RTHC by parents, as well as inadequate use of RTHC by health professionals, have lessened its efficacy and purpose. Objectives: This study aimed to describe the level of possession of the RTHC by a sample of caregivers of patients admitted to Red Cross War Memorial Children's Hospital (RCWMCH), and to determine the extent and accuracy of doctors' transfer of clinical information between the RTHC and hospital records. Methods: A cross-sectional and analytical study was conducted in four general paediatric wards at RCWMCH. Consecutive patients were enrolled at discharge during office hours over a six week period. Data were extracted from a photograph of the RTHC and the participant's hospital record. Both the 1995 Chart version and the 2009 Booklet version of the RTHC were included in the study. The presence or absence of selected items of information on the RTHC and the hospital record were recorded - the primary outcome was the transfer of the specified information between records. The outcomes are presented as proportions, with 95% confidence intervals (CI).
22
Copelyn, Julie. "Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22761.
Full textAbstract:
Background: The large scale-up of paediatric HIV care necessitated down-referral of many children receiving antiretroviral therapy (ART) from Red Cross War Memorial Children's Hospital (RCWMCH). No published data exists on the outcomes of these children. Objectives: To assess clinical, immunological and virological outcomes of children receiving ART in the first 12 months after down-referral to primary health care (PHC) clinics, and identify determinants of successful down-referral. Methods: We conducted a retrospective cohort study of children <15 years of age who commenced ART at RCWMCH and were subsequently down-referred to one of two PHC clinics between January 2006 and December 2012. Baseline characteristics of patients and caregivers as well as CD4 counts, viral loads and weights were collected at 6 and 12 months post-down-referral. Outcomes included retention in care and viral suppression. Results: One hundred and sixteen children down-referred to Heideveld and Gugulethu were included. After down-referral 13.8% of the cohort never arrived at the designated clinic and 10% took longer than 8 weeks, therefore probably experiencing treatment interruption. At 12 months post down-referral only 68.2% remained in care at the designated clinics. No factors were associated with retention in care. For those children who remained in care at the PHC clinics, the clinical and immunological gains achieved prior to down-referral were sustained through 12 months of follow up, and 54.7% of the retained cohort had documented viral suppression at 12 months. Conclusion: Down-referral of children on ART is a vulnerable process with risk of loss to follow-up and treatment interruption.
23
Mwaba, Chisambo. "A ten year retrospective study of the aetiology and outcome of crescentic glomerulonephritis in children presenting to the Red Cross Children's Hospital, Cape Town, South Africa." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24500.
Full textAbstract:
Background: Crescentic glomerulonephritis represents the extreme end on the spectrum of glomerular injury. It can result from a wide range of disease conditions and clinically is marked by a rapid deterioration in renal function over days, weeks or months. Although rare, crescentic glomerulonephritis is an important entity to recognize because prompt treatment can improve patient outcomes significantly. Literature on the prevalence, clinical presentation, aetiology and outcome of histologically proven crescentic glomerulonephritis among children, in Africa, is scanty. Most of what is known about this entity is extrapolated from adult studies and from paediatric studies that have for the most part been conducted outside the African continent. Objective: This study was conducted in order to determine the incidence, clinical presentation, aetiology and outcome of histologically proven crescentic glomerulonephritis in children presenting to the Red Cross Children's Hospital, Cape Town, South Africa. Methods: This was a retrospective folder review in which the renal biopsy records of children less than 18 years old who had had native kidney biopsies performed between 2004 and July 2015 at the Red Cross Children's Hospital were reviewed. The clinical notes of patients found to have been diagnosed with crescentic glomerulonephritis were traced so as to extract demographic and clinical information which was then recorded onto the study data sheet. No attempt to contact patients or their families was made. Data analysis with regard to the incidence, the clinical features and the outcome of crescentic glomerulonephritis was done using SPSS version 22. Results: A total of 470 native kidney biopsies were performed in the period under review. Of these, 24 had crescentic glomerulonephritis, accounting for an incidence of 5.1 %. The sub-types of crescentic glomerulonephritis were immune-complex in 19 (80%), Pauci-immune in 2 (8 %), unspecified type in 3 (12 %) and no child had the anti-glomerular basement membrane subtype. The underlying aetiology of the immune complex sub-type was post-infectious in 11(57.9%), idiopathic in 4(21%), HSP/IgA nephropathy in 2 (10.5%), SLE in 1 (5.3%) and mesangiocapillary glomerulonephritis in 1(5.3%). Fourteen of the subjects were male thus giving a male to female ratio of 1.4 while the mean age of the children was 8.3 [range- 1 to 14 years]. The commonest clinical features were hypertension (90%), nephrotic range proteinuria (80%), macroscopic haematuria (57%), oedema (94%) and anaemia (88%). None of these had a statistically significant association to the renal outcome. Ten (77%) out of the 13 children with crescentic glomerulonephritis who were followed up for more than a year were found to have either died, had residual renal dysfunction or been transplanted at the last clinical contact. Conclusion: Crescentic glomerulonephritis was diagnosed in 5.1% of paediatric native renal biopsies which is consistent with what has been reported elsewhere. Unlike reports from other geographical areas the vast majority (80%) of the cases had immune-complex glomerulonephritis with a suspected post-infectious aetiology in over half of these. Similar to earlier reports from South Africa the outcome was poor in most (77%) of the patients. Further research is required to characterise the factors that make post-infectious glomerulonephritis particularly severe in this population.
24
Mogere, Edwin. "Impact of secondary insults on the outcome of paediatric traumatic brain injury : a retrospective cross sectional study at the Red Cross Children’s Hospital, Cape Town." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/13970.
Full textAbstract:
Includes bibliographical references.Secondary insults in severe traumatic brain injury (TBI) may worsen outcome; however, these are poorly characterized in children. For example, despite the known association between intracranial pressure (ICP) and poor outcome, there are few large paediatric series on the subject, definitions vary, functional outcome is often not assessed, and the best measures to assess ICP for statistical analysis are unknown. We aimed to document the frequency of secondary insults, and the association of various ICP measures, with outcome in a large cohort of paediatric patients with severe TBI. A retrospective analysis of 5-year prospectively collected data was examined for the frequency of hypoxia, hypotension, raised ICP, and low cerebral perfusion pressure (CPP). ICP parameters included initial ICP, mean ICP in the first 24 hours, mean ICP overall, peak ICP, mean ICP over 20 mmHg, and episodes of ICP over 20 mmHg. Hypotension was defined by age †and height †adjusted mean arterial pressure ranges, and hypoxia was defined as arterial partial pressure of oxygen (PaO2) less than 8kPa or pulse oximetry less than 90%. We examined for univariate and multivariate associations with mortality and the Extended Paediatric Glasgow Outcome Score.
25
Oosthuizen, Nicolene. "A profile of a paediatric population with feeding and swallowing difficulties at a tertiary hospital in the Western Cape." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/2931.
Full textAbstract:
Includes abstract.Includes bibliographical resources.
Feeding and/or swallowing difficulties (FSD) have been associated with some of the leading causes of infant and child mortality in South Africa. Preventable conditions such as lower respiratory tract infections (LRTI) and under-nutrition may be caused by FSD. FSD are frequently reported in paediatric populations and may occur with various medical co-morbidities. The nature of FSD is however under described and information specific to developing countries is scarce. Furthermore, limited information regarding the service delivery requirements of the paediatric population with FSD is available. To describe in a paediatric population: the nature and frequency of FSD, the nature of FSD in different medical conditions or participant characteristics, and the nature of the services and interventions received by infants and children with FSD. A descriptive, retrospective survey design was used to examine the medical records of 446 infantsand children aged less than 13 years who accessed services for FSD at a paediatric tertiary hospital from January 2007 to December 2009. Seventy percent of participants were under the age of 2 years at the time of first assessment. The nature of participants’ FSD, the medical conditions present, and services/interventions received were recorded. The data were described and associations were analysed statistically. Infants and children with FSD often presented with various medical co-morbidities affecting multiple organ systems with neurologic and gastro-intestinal tract conditions occurring most frequently. A third (34%) of the participants had confirmed aspiration on instrumental assessment. Participants with confirmed aspiration presented with statistically significantly more aspiration pneumonia (x2 = 26.4314, p <; .001) and unspecified LRTI (x2 = 21.2757, p <; .001) than those without aspiration. Participants required a range of services for FSD from Speech-Language Therapists (SLT) as well as medical intervention, and surgical procedures. Most participants (91%) received intervention for FSD for an average of 6 months with a mean of 6 SLT consultations. Forty-three percent of participants completed intervention while 20% continued to receive intervention. The present study profiled paediatric FSD in the Western Cape, South Africa. Infants and children with FSD presented with varied and multiple underlying medical conditions. The safety of swallowing was often (34%) compromised in this population which may have affected respiratory health negatively. Infants and children with FSD frequently presented with LRTI and growth faltering/under-nutrition, two of the leading causes of death in children under the age of 5 years. There is a need for dysphagia services at primary and district levels of health care in the Western Cape to detect and prevent paediatric FSD. While the management of FSD requires the collaboration of many health care professionals, the inclusion of SLTs and dieticians into primary and district level teams may assist with the identification of FSD for early intervention and may prevent FSD-related LRTI and undernutrition in infants and children with FSD
26
Washaya, Norbertta Nzwisisayi. "A prospective study to assess the value of liquid chromatography-tandem mass spectrometry in the management of paediatric poisoning at Red Cross War Memorial Children's Hospital, Cape Town, South Africa." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/33972.
Full textAbstract:
Background: Paediatric poisoning is a common presentation to emergency departments worldwide. There is a paucity of data on the role of liquid chromatography-tandem mass spectrometry (LC-MS/MS), in the management of paediatric poisoning in low-and middle-income countries (LMICs). In high-income countries, most studies are retrospective, and few include children. Objective: The study describes the prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Methods Children admitted with suspected poisoning between 1 January 2017 and 31 December 2017, were recruited. All patients had a urine and/or blood sample sent for LC-MS/MS toxicology. Data collected included demographic data, clinical features, investigations, management, outcome and social interventions. Results 152 children, with median age of 39 (IQR 25 -61) months were enrolled of which 128 (84%) were poisoning cases. Of the 128 poisoning cases, 88 (69%) presented with a history of ingesting a known substance, 16(12%) an unknown substance and 24(19%) were cases of occult poisoning. LC-MS/MS was able to identify a substance in 92% of the cases of occult poisoning. In those who had presented with a seemingly known substance, LC-MS/MS found a different substance in 15 cases. LC-MS/MS was also able to detect multiple drugs in 40 patients. Of the poisoning cases, six (5%) cases were attempted homicide cases and 5 (4%) cases were attempted suicide cases. No children died. Individualized social interventions were instituted in poisoning cases. Emergency placement safety reasons was required in 6 children. Conclusion: When the limitations are known, LC-MS/MS is useful in identifying cases of occult poisoning; identifying patients who have ingested multiple substances and/or an unknown substance and when targeted towards child protection. As LC-MS/MS is an expensive test, it should be used judiciously in LMICs.
27
Will, R. G. "Quality of paediatric care at King Edward VIII hospital." Thesis, 1987. http://hdl.handle.net/10413/7954.
Full textAbstract:
The purpose of health service research is to produce knowledge that will contribute to the improvement in the delivery of health care and it is in
this spirit that this study of the quality of paediatric care at King Edward VIII Hospital was undertaken. The main method utilized was an evaluation of aspects of the process of care of selected conditions, as measured against a predefined set of standards. This was accomplished by a retrospective review of patient records. Assessments were also made of the utilization of the Department's services, manpower and equipment. The surveys conducted involved the Outpatient's Department, the General and the Neonatal Wards of the Paediatric Department of the King Edward VIII Hospital, Durban. The Hospital Administration's routine and computerized data were also analyzed. Among the findings was that the routinely collected data is inadequate,providing only limited information for management purposes. The assertion that the utilization of the Department is high was confirmed, as was the claim that some resources are inadequate to cope with increasing demand. Many factors contribute to this, including high bed occupancy, high patient to doctor ratios, and several factors outside of direct hospital control (primary care services). The general clinical care of patients is high, but particular aspects were found to be in need of attention; for example, the metabolic and fluid management of the ill young patient and medical records in general.
Immediate and long-term recommendations pertaining to the Paediatric Department and the Administration are presented.
28
Stein, Christopher Owen Alexander. "Pre-hospital emergency care student experience with paediatric emergency cases in Johannesburg, Gauteng." Thesis, 2011. http://hdl.handle.net/10539/9171.
Full textAbstract:
MSc (Med) Emergency Medicine, Faculty of Health Sciences, University of the WitwatersrandAdequate exposure to paediatric pre-hospital emergency cases for students undertaking clinical learning is a key component of preparation for independent practise. Both clinical reasoning and psychomotor skills require practise in a realistic environment in order to best equip the qualifying practitioner for demands of the real world of pre-hospital emergency care. The aim of this study was to retrospectively describe the exposure of pre-hospital emergency care students in the University of Johannesburg‟s National Diploma in Emergency Medical Care programme to emergencies involving paediatric patients in the Greater Johannesburg Metropolitan area over a continuous eight year period, between 1 January 2001 and 31 December 2008. Patient care records contained in an electronic clinical learning management information system entered over the eight-year study period were analysed in order to characterise the exposure of students to paediatric emergency cases in general, and clinical skills performed during this exposure. Results showed that, with the exception of infants and children seen by first year students, median exposure to paediatric emergency cases for students in all academic years was below 50%. Exposure to emergencies involving younger patients was generally lower than that for older patients, however the acuity of patients increased with decreasing age. Exposure to most clinical skills also decreased with decreasing patient age. Opportunities for students to practise critical or invasive skills were relatively rare. Suggestions for the improvement of student exposure to paediatric emergency cases and clinical skills include a period of internship and greater utilisation of hospital-based clinical skills exposure and practice.
29
Mopeli, Refiloe Keketso. "An audit of primary medical conditions in children admitted to paediatric intensive care unit of Charlotte Maxeke Johannesburg academic hospital." Thesis, 2017. http://hdl.handle.net/10539/23297.
Full textAbstract:
A research report submitted to the Faculty of health Sciences, University of the Witwatersrand, Johannesburg, in particular fulfillment of requirements for the degree of Masters in Medicine (MMed)
Johannesburg,MT2017
30
Ahn, Seung-Hye. "Factors associated with nosocomial fungal sepsis among patients in the paediatric intensive care unit at the Chris Hani Baragwanath academic hospital." Thesis, 2017. http://hdl.handle.net/10539/23349.
Full textAbstract:
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg in partial fulfillment of the requirements for the degree of
Master of Medicine in the branch of Paediatrics and Child Health
29 May 2017Introduction Sepsis, and in particular, severe sepsis, remains a major cause of death in children worldwide. One of the areas where the burden of sepsis is keenly felt is in the paediatric intensive care unit (PICU) setting, contributing significantly to childhood mortality. Fungal organisms have emerged as a major organism contributing to nosocomial sepsis in PICU. No local data regarding nosocomial fungal sepsis in the non-neonatal, PICU population exists regarding this matter. This study describes the characteristics of patients with nosocomial fungal sepsis in the PICU at South Africa’s largest hospital Chris Hani Baragwanath Academic Hospital (CHBAH). Methods This study was a retrospective review of patient records. All patients aged 0-16 years admitted to the PICU at Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2008 through December 2011 were assessed. A total of seventeen patients who developed nosocomial fungal sepsis were included in this study. Results The incidence of candidaemia was reported to be 3.2 per 100 cases. The major age group affected by nosocomial fungal sepsis was the under one age group. The most common diagnoses on admission were lower respiratory tract infection (LRTI) followed by haematology-oncology and acute gastroenteritis cases. ICU factors found to commonly co-‐exist with proven nosocomial fungal sepsis were presence of a central venous catheter (100%), mechanical ventilation (82%), arterial line (70%), and systemic corticosteroid use (47%). The penicillin class was the most common antimicrobial that patients were found to be on at the time of nosocomial sepsis. The most common fungal organism as a cause for nosocomial sepsis was C. parapsilosis rather than C. albicans. Furthermore, the majority of this study’s isolates were susceptible to voriconazole rather the current empiric antifungal of choice, namely fluconazole. Conclusion The presence of central venous catheters, arterial lines, mechanical ventilation and systemic corticosteroid use is common in paediatric patients with nosocomial fungal sepsis. However, this study was unable to determine statistically significant factors associated with fungal sepsis in a tertiary PICU due to the surprisingly small number of cases (n=35) detected over a four-year period. This perhaps represents the most striking finding of the study together with a concerning pattern of fluconazole resistance (14%) among isolated organisms.
MT2017
31
Verwey, Michelle Kim. "Managing guidelines to support parents with the hospitalisation of their child in a private paediatric unit." Thesis, 2008. http://hdl.handle.net/10210/767.
Full textAbstract:
The purpose of this research study was to describe managerial guidelines to support parents with the hospitalisation of their child in a private paediatric unit. The study explored and described: · the nursing care experiences of parents regarding the hospitalisation of their child in a paediatric unit; · managerial guidelines to support parents with their lived experiences of their child’s hospitalisation in a private paediatric unit. To achieve the purpose and the objectives of the research, an interpretivephenomenological qualitative approach was used in the research design and method. Various questioning methods were employed during this study. Parents were invited to take part in unstructured individual interviews to ascertain parents’ experiences of their child’s hospitalisation. A narrative diary was used as the second method of questioning and parents were asked to narrate their lived experiences of their child’s hospitalisation in a private paediatric unit. During the study the researcher kept field notes as she participated in the fieldwork. The data obtained was then incorporated into existing literature during the conceptualisation phase. The population and sampling for this study consisted of seven parents who took part in the interviews and 15 parents who completed the narrative diaries. Purposive sampling was used to achieve saturation of data. The model of Guba and Lincoln (1985) was used to ensure trustworthiness. Ethical considerations were maintained throughout the study and consent was obtained from the respondents. The recommendations of the research were that attention should be given to: · empowering parents to participate in certain aspects of their child’s care to the extent and intensity that they feel comfortable with, recognising parents’ strengths and intrinsic characteristics and minimising feelings of parental guilt created by social roles; · guiding nursing personnel to plan the discharge process effectively; · including parents in the unit routine and managing resources whilst promoting cost containment; II · interpersonal relationships in the paediatric unit, with special emphasis on fostering a trusting and caring relationship between parents and nursing care professionals · promoting the communication of information by using a communication style that ensures parents receive adequate information; and · creating a safe, therapeutic environment for parents, where parents can be comfortable with adequate facilities and minimal external stimuli.Prof. K. Jooste
32
Sinyela, Nkhumiseni. "The usage of antibiotics in paediatric patients while admitted to the intensive care unit at a public tertiary hospital." Thesis, 2018. https://hdl.handle.net/10539/25449.
Full textAbstract:
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment for the degree of Masters of Science in Medicines: Pharmaceutical Affairs.
June 2018.Background: The overuse and misuse of antibiotics decreases their effectiveness and results in increasing bacterial resistance which is considered an international public health crisis. Antibiotics are one of the most commonly used groups of medicines in peadiatric patients however there are limited data available on the usage of antibiotics in paediatrics globally but especially in South Africa. The aim of this study was to conduct a retrospective review of antibiotics used in paediatric patients in intensive care. Method: This study reviewed antibiotic therapy from patient charts in the Intensive Care Unit at Charlotte Maxeke Johannesburg Academic hospital. The review was done from 15 January 2016 to 15 February 2016 and 15 January 2017 to 15 February 2017. Results: There were 40 files reviewed for 2016 and 55 files for 2017. Most patients (2016: 78% and 2017: 60%) were neonates aged between 0 -3 months. There were 15 antibiotics prescribed in 2016 and 2017 that differed between the two study periods. The most frequently prescribed antibiotics in 2016 were: vancomycin (19%), imipenem (18%), ampicillin (11%) and gentamycin (11%). In comparison in 2017, the most frequently prescribed antibiotics were meropenem (21.7%) vancomycin (20.8%) and co-amoxiclav (11.7%). In both periods majority of patients received two antibiotics as therapy during their ICU stay, 47.5% in 2016 and 40% in 2017. The average numbers of days in ICU were 5 days in 2016 and 4 days in 2017. Diagnosis classifications were similar between the two study periods. Cultures (blood) were ordered in 73% (2016) compared to 75% (2017). C-reactive protein samples were taken from 85% of patients in 2016 and 82% in 2017. In 2017, there were 46.2% (n=36) of doses with a hang time less than 60 minutes and 32.5% (n=26) in 2016. Conclusion: This study showed that most antibiotics were prescribed empirically with imipenem and vancomycin the most used combination antibiotic therapy in 2016, meropenem and vancomycin in 2017. Majority of patients received two antibiotic therapies during their ICU stay. CRP and cultures (blood) were frequently ordered and hang time mostly documented. Prescription of antibiotics was mostly compliant with the unit antibiotic prescription guidelines.
LG2018
33
Keeling, Kathryn Helen. "Patient characteristics and determinants of outcomes of children admitted with pneumonia to a Paediatric Intensive Care Unit (SLE) in a Tertiary Hospital in Johannesburg." Thesis, 2017. https://hdl.handle.net/10539/24756.
Full textAbstract:
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Medicine in the branch of Paediatrics.
Johannesburg, 2017.Background. Pneumonia is the leading infectious cause of death worldwide. HIV infected and exposed children are at greater risk for developing pneumonia. HIV exposed infants have been said to have a worse outcome than their HIV unexposed counterparts. Objectives. To describe the patient characteristics and determinants of the outcome of children admitted to the paediatric intensive care unit (PICU) with pneumonia. Methods. This was a retrospective review of patients admitted to a PICU between 1 January 2013 and 31 December 2014. Results. One hundred and seven patients were analyzed, of these 65.4% had a normal weight for age. Fifty percent of patients were HIV unexposed, 21.5% HIV infected and 26.2% HIV exposed but uninfected. The HIV infected group had a significantly longer length of stay (p= .011), duration of ventilation (p= .003) and higher mortality (p= .014) when compared to the HIV uninfected group. Likewise compared to HIV exposed but uninfected children, HIV infected had a longer length of stay (p=. 006), duration of ventilation (p= .003) and a greater mortality (p= .038). When the oxygenation index is ≥16, patients had a longer duration of ventilation (p= .037) and they had an increased risk of mortality (p< .001) Multiple regression showed that oxygenation index was the only significant predictor of death. Conclusion. HIV infected children had a significantly higher mortality than both HIV uninfected and HIV exposed but uninfected children. An oxygenation index of greater than 16 is a significant predictor for longer duration of mechanical ventilation and death.
LG2018
34
Armstrong, Ruth Elizabeth. "The effect of music therapy on self-reported affect in hospitalised paediatric patients : a thesis submitted to the New Zealand School of Music in partial fulfilment of the requirements for the degree of Master of Music Therapy." 2009. http://hdl.handle.net/10179/1208.
Full textAbstract:
The present research examines the effect of music therapy on the affect of hospitalised children. It took place on a paediatric ward of a New Zealand public hospital. This study aimed to investigate the role of music therapy in addressing patients’ psychosocial needs. Literature on the impact of hospitalisation, and on the use of music therapy in hospitals and paediatrics was reviewed. The research involved an audit of the therapist’s clinical notes from music therapy sessions over the course of seven months. The clinical notes included measurements of children’s mood from the beginning and end of sessions, using McGrath’s (1990) Affective Facial Scale. It was hypothesised that mood measures following music therapy would be higher than pre-music therapy scores. Statistical analysis of the facial scale data did not show a significant difference between ‘before’ and ‘after’ measures. These results were discussed with regard to a ceiling effect (this is, the measurements indicated patients were at the happy end of the scale before the music therapy session, so there was little room on the scale for mood to improve following music therapy). The measurement of emotion did not prove to be straightforward. The hospital environment may have influenced the patients’ responses in a number of ways. These environmental influences are discussed with reference to examples from the clinical notes. The usefulness of facial scales in this context is discussed, as well as other limitations of the research. Suggestions for future research include the use of other mood measures, and the inclusion of measurements of parental mood and how this affects the child.
35
Královec, Jiří. "Charta práv dětí v nemocnici ("EACH Charter") jako nástroj posilování a ochrany etických aspektů pediatrické hospitalizace." Master's thesis, 2020. http://www.nusl.cz/ntk/nusl-448716.
Full textAbstract:
The Charter of rights of children in hospital (the EACH Charter) is an international document authored by the European Association for Children in Hospital (EACH) in the eighties of the twentieth century. The Charter can be perceived as a response to the fact that a child's stay in hospital - and paediatric hospital as an institution - is strongly influenced and formed by economical, technological and administrative aspects prevailing over the ethical ones. The Charter highlights specific situations where the health care profession - by neglecting children's needs and ignoring and/or tolerating avoidable suffering - becomes unethical. The aim of my thesis is to scrutinize the ethical appeal of the EACH Charter and to explore the Charter's ethical implications for contemporary paediatric practice in the Czech Republic.